ENDO terminology

Question 1

When should you consider a non odontogenic source?

Answer 1

if no identifiable cause, history of clinical findings are inconsistent with odontogenic pain

Question 2

spontaneous pain with a hx of previous pain in the same tooth usually indicate what?

Answer 2

presence of severe and irreversible pulpitis

If patient has been “delaying the treatment for a few year”- typically NOT an endo issue???

Question 3

T/F

Odontogenic pain often crosses the midline?

Answer 3

FALSE!!! very rarely

Question 4

why might you wait to localize the tooth?

Answer 4

when the inflammation goes to the PDL, usually the patient will feel this upon percussion

Question 5

30% of patients in the beginning stages cannot localize pain
T/F?

Answer 5

true

Question 6

If you cannot localize the pain, and have been following the patient for a month, what do yo think the cause of??

Answer 6

not endo

These issues can be less than 10%

Question 7

Periodical disease of endodontic origin is mediated by ____

Answer 7

bacteria

Question 8

what are the two components of an endo diagnosis?

Answer 8

pulpal and periapical

Question 9

is condensing osteotis periodical or pulpal?

Answer 9

periapical

Question 10

give an example of an endo diagnosis?

Answer 10

8 pulp necrosis with asymptomatic apical periodontist

REMEMBER, it needs the two components

Question 11

How long does a “normal” cold/heat response last?

Answer 11

3-10 seconds is “normal” but it also depends on what is NORMAL to the patient

Find a control somewhere in the mouth. Compare the tooth in question to the control

Question 12

Describe reversible pulpitis?

Answer 12

this means that subjective and objective findings indicate that inflammation is present, but should resolve WITHOUT a root canal.

You keep the tooth alive in this scenario, but there is something you need to work on

Question 13

what might cause reversible pulpitis?

Answer 13

hx of a recent restoration (usually an amalgam, composite, or crown prep) within several days to a few weeks

• Often a first time complaint!
• symptoms resolve quickly after the stimulus is removed
• NO RADIOGRAPHIC CHANGES YET

If patient just had a big filling a few days ago- tell patient to wait about 2 weeks because that’s normal and expected to be heat sensitive or sensitive in general Test the same day though to establish a baseline, wait two weeks, and then see if anything has changed.

Question 14

Describe irreversible pulpitis:

Answer 14

Symptomatic and asymptomatic.
The reality is that the pulp is INFLAMMED, but cannot be fixed with conservative therapy.

Symptomatic usually comes with LINGERING thermal pain, spontaneous, and referred pain. Does it start on it’s own? How long does it last?

Asymptomatic- there are no clinical SYMPTOMS, but inflammation typically produced by caries, excavation, or trauma

Question 15

In an adult, a carious pulp exposure likely leads to what?

Answer 15

endo treatment in the very near future

Question 16

Why is irreversible pulpits difficult for students to figure out?

Answer 16

it’s difficult to localize!!!!! often presents with NO symptoms, or a LARGE range of symptoms

Question 17

T/F

Irreversible pulpitis will always respond to EPT/COLD?

Answer 17

TRUE!!!
symptomatic will have an ABNORMAL response, and ASYMPTOMATIC will have NORMAL!!!!

radiograph generally reveals widened PDL, or it can be WNL

Question 18

T/F

EPT and COLD test blood supply?

Answer 18

false!!! just the nerve

Question 19

when you are doing an EPT test, what are you looking for???

Answer 19

The numbers DON’T MEAN ANYTHING!!! Basically- if it doesn’t react AT ALL, then that’s NO BUENO. EPT is like a pregnancy test- NO DEGREES!!!

The numbers are just the strength of the current

Question 20

If you have a lot of sclerotic dentin or tertiary dentin, how does this effect EPT?

Answer 20

yes, still works

Question 21

what is the more accurate test? EPT or COLD test?

Answer 21

cold…

Question 22

why might you have a false negative with cold test?

Answer 22

calcified canal.

Anytime a tooth doesn’t respond to the cold test, you have to do a follow up….

Question 23

If your tooth responds poorly to pain, with lingering pain with cold test, do you need to EPT test?

Answer 23

no, because you know it’s already inflamed and compromised

Question 24

If patient has a crown, and didn’t respond to cold, what might you do?

Answer 24

percussion

Question 25

Why are we “guessing” at all times with our endo tests?

Answer 25

we can never test blood supply WHICH means you are purely SPECULATING about the true histological diagnosis. You have to look at chief complaint, radiographic, clinical assessment and see if adds up to a straight forward diagnosis

Question 26

If caries is in the pulp, where are you automatically?

Answer 26

irreversible.

It could be necrotic though

Question 27

T/F

Necrotic often have a worse chance of healing?

Answer 27

true???

Question 28

Asymptomatic irreversible pulpitis

Answer 28

decay is encroaching on the pulp but patient responds normally? Caries exposure would result in PULP EXPOSURE

Question 29

When you evaluate the extent of decay, what radiographs should you have?

Answer 29

BITEWINGS ALWAYS!!!!!

Question 30

T/F

Irreversible pulpits may refer pain to the opposing arch?

Answer 30

true!

it could be to adjacent areas! So it won’t cross the midline, but it can refer and cross arches, but NOT THE MIDLINE!!!!

Question 31

what type of endo has the highest incidence of referred pain?

Answer 31

IP

Question 32

pts often taking analgesic

Answer 32

IP

If patient is a pill popper, think about IP. Ask when they took the last dose when you are trying to diagnose. IBUPROFEN might interfere and mask.

Narcotics and tylenol will NOT have that…but Ibuprofen and antifilammatories can skew the results.

Question 33

Is blood supply or nerve supply lost faster???

Answer 33

BLOOD SUPPLY LOST MUCH FASTER than nerve supply.

Question 34

previously treated vs. previously initiated?

Answer 34

previously initiated means they may have started but didn’t finish

Question 35

If a tooth has been previously endo treated, can you now say that it has normal apical tissues?

Answer 35

yes, this works for previously treated teeth as long as the lamina dura is intact and PDL space is normal

Question 36

teeth with biting or percussion/palpation sensitivity

Answer 36

symptomatic apical periodontitis

Radiolucent lesion may or MAY NOT be present

Question 37

describe Asymptomatic apical periodontis?

Answer 37

infalmmation and destruction of the apical peridontium that is of PULPAL origin!!!!

Appears as apical radiolucent area but NO clinical symptoms!!!!

Question 38

Describe an acute apical abscess?

Answer 38

SWELLING!!! that’s means AAA…

Immune response typically in first 42-78 hours…NOT a chronic issue here. You can have an acute exacerbation of a chronic problem but you would still classify this as ACUTE

Question 39

if you have an acute exacerbation of a chronic problem, do you classify this as chronic or acute?

Answer 39

acute…this is what will dictate your treatment

Question 40

If you have acute apical abscess, is tooth usually vital or necrotic?

Answer 40

at this point, usually necrosis and infection

Question 41

Describe chronic apical abscess?

Answer 41

they are typically gradual onset with little or no discomfort. Intermittent discharge of pus through a sinus tract

BIGGIE is the draining SINUS tract…